title: A sustained virologic response reduces risk of all-cause mortality in patients with hepatitis C.
abstract: OBJECTIVE
  The effectiveness of hepatitis C virus (HCV) treatment with pegylated interferon and ribavirin usually is evaluated by the surrogate end point of sustained virologic response (SVR), although the ultimate goal of antiviral treatment is to reduce mortality. The impact of SVR on all-cause mortality is not well documented by HCV genotype or in populations in routine medical practice with substantial comorbidities.
  
  
  METHODS
  From the US Department of Veterans Affairs (VA), we identified all patients infected with HCV genotypes 1, 2, or 3, without human immunodeficiency virus co-infection or hepatocellular carcinoma before HCV treatment with pegylated interferon and ribavirin, who started HCV treatment from January 2001 to June 2007, stopped treatment by June 2008, and had a posttreatment HCV RNA test result of SVR or no SVR. Mortality data from VA and non-VA sources were available through 2009.
  
  
  RESULTS
  HCV genotypes 1, 2, or 3 cohorts consisted of 12,166, 2904, and 1794 patients, respectively, with SVR rates of 35%, 72%, and 62%, respectively. Each cohort had high rates of comorbidities. During a median follow-up period of approximately 3.8 years, 1119 genotype-1, 220 genotype-2, and 196 genotype-3 patients died. In genotype-specific multivariate survival models that controlled for demographic factors, comorbidities, laboratory characteristics, and treatment characteristics, an SVR was associated with substantially reduced mortality risk for each genotype (genotype-1 hazard ratio, 0.70; P < .0001; genotype-2 hazard ratio, 0.64; P = .006; genotype-3 hazard ratio, 0.51; P = .0002).
  
  
  CONCLUSIONS
  An SVR reduced mortality among patients infected with HCV of genotypes 1, 2, or 3 who were being treated by routine medical practice and had substantial comorbidities.
authors.affiliation: Center for Quality Management in Public Health, Veterans Affairs Palo Alto Health Care System, California, USA. lisa.backus@va.gov
authors.forename: Lisa I
authors.initials: LI
authors.lastname: Backus
authors.forename: Derek B
authors.initials: DB
authors.lastname: Boothroyd
authors.forename: Barbara R
authors.initials: BR
authors.lastname: Phillips
authors.forename: Pamela
authors.initials: P
authors.lastname: Belperio
authors.forename: James
authors.initials: J
authors.lastname: Halloran
authors.forename: Larry A
authors.initials: LA
authors.lastname: Mole
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage*; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification*; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000401:mortality* / Q000821:virology*; D006801:Humans; D007372:Interferons / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012254:Ribavirin / Q000008:administration & dosage; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons